Mrs Sarah Jane Hobson1, Ms Theresa Bourke, Mrs Sarah Hobson, Mr Sam Graham, Dr Michelle Kendall, Dr Omar Khorshid
1Fiona Stanley Fremantle Hospitals Group, Perth, Australia
Biography:
Sarah Jane Hobson is an experienced physiotherapist and healthcare leader with a Master's in Public Health from the University of Western Australia. Currently serving as Principal Project Officer at Fremantle Hospital, she is the Allied Health Representative on the Short Stay Arthroplasty Project. This project aims to implement a short stay pathway for hip and knee arthroplasty patients. Sarah's expertise in operational management, and stakeholder engagement has contributed to the development of evidence-based guidelines, with the goal of improving patient outcomes and reducing length of stay. Her leadership showcases a commitment to advancing healthcare services through collaborative and data-driven approaches.
Abstract:
Background:
Short stay pathways in hip and knee arthroplasty have shown success in achieving 0 – 1 day length of stay (LOS). Key features include short-acting spinal anaesthetic, no routine indwelling catheters (IDC), early mobilisation, managing patient expectations, and care coordination. This project aimed to describe current clinical practice at Fremantle Hospital and LOS compared to features of short stay arthroplasty programs.
Method:
A retrospective audit of all patients admitted to Fremantle Hospital between January and September 2024 for ‘hip replacement non-trauma, major or minor complexity’ or ‘knee replacement, major or minor complexity’ was undertaken. A prospective audit of time to mobilisation was completed between 14 March and 13 June 2024. Data was retrieved from admission databases and clinical records. Current clinical practice was descriptively analysed and summarised.
Results:
334 cases were audited retrospectively. Regarding anaesthesia, 39 (11.7%) had a short-acting spinal, 129 (38.6%) had a general anaesthetic, and 166 (49.7%) had intrathecal morphine. 274 (82.0%) had an IDC. 130 cases were prospectively audited with 22 (16.9%) mobilised on Day 0. Mean LOS was 4.4 days regardless of anaesthetic type, IDC use or Day 0 mobilisation. No care coordination role or coordinated patient education was identified.
Discussion:
Despite experiencing some features of short stay models of care, patients did not experience a shorter length of stay. Achieving a reduction in LOS with good patient outcomes requires a comprehensive, coordinated model of care, clinical resourcing, and a patient education program.